Maternal Satisfaction as an Outcome Criterion in Research on Labor Analgesia

Background Continuous intrathecal labor analgesia produces rapid analgesia or anesthesia and allows substantial flexibility in medication choice. The US Food and Drug Administration, in 1992, removed intrathecal microcatheters (27-32 gauge) from clinical use after reports of neurologic injury in nonobstetric patients. This study examined the safety and efficacy of a 28-gauge intrathecal catheter for labor analgesia in a prospective, randomized, multicenter trial. Methods Laboring patients were randomly assigned to continuous intrathecal analgesia with a 28-gauge catheter (n = 329) or continuous epidural analgesia with a 20-gauge catheter (n = 100), using bupivacaine and sufentanil. The primary outcome was the incidence of neurologic complications, as determined by masked neurologic examinations at 24 and 48 h postpartum, plus telephone follow-up at 7-10 and 30 days after delivery. The secondary outcomes included adequacy of labor analgesia, maternal satisfaction, and neonatal status. Results No patient had a permanent neurologic change. The continuous intrathecal analgesia patients had better early analgesia, less motor blockade, more pruritus, and higher maternal satisfaction with pain relief at 24 h postpartum. The intrathecal catheter was significantly more difficult to remove. There were no significant differences between the two groups in neonatal status, post-dural puncture headache, hemodynamic stability, or obstetric outcomes. Conclusions Providing intrathecal labor analgesia with sufentanil and bupivacaine via a 28-gauge catheter has an incidence of neurologic complication less than 1%, and produces better initial pain relief and higher maternal satisfaction, but is associated with more technical difficulties and catheter failures compared with epidural analgesia.

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Effect of companion presence on maternal satisfaction during neuraxial catheter placement for labor analgesia: a randomized clinical trial

International Journal of Obstetric Anesthesia ◽

10.1016/j.ijoa.2018.10.010 ◽

2019 ◽

Vol 38 ◽

pp. 66-74 ◽

Cited By ~ 2

Author(s):

E. Morell ◽

F.M. Peralta ◽

N. Higgins ◽

A. Suchar ◽

P. Fitzgerald ◽

...

Keyword(s):

Clinical Trial ◽

Randomized Clinical Trial ◽

Labor Analgesia ◽

Catheter Placement ◽

Maternal Satisfaction

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A Meta-Analysis of Comparing Intermittent Epidural Boluses and Continuous Epidural Infusion for Labor Analgesia

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17197082 ◽

2020 ◽

Vol 17 (19) ◽

pp. 7082

Author(s):

I-Shiang Tzeng ◽

Ming-Chang Kao ◽

Po-Ting Pan ◽

Chu-Ting Chen ◽

Han-Yu Lin ◽

...

Keyword(s):

Local Anesthetic ◽

Meta Analysis ◽

Labor Analgesia ◽

Epidural Infusion ◽

Instrumental Delivery ◽

Maternal Satisfaction ◽

Continuous Epidural Infusion ◽

Second Stage Of Labor ◽

Mean Differences ◽

Cesarean Delivery Rate

With the development of medical equipment and techniques in labor anesthesia, it is a major issue to investigate the risks and treatment effects among techniques such as continuous epidural infusion (CEI) and intermittent epidural bolus (IEB). However, there is a controversial result regarding two techniques. This study was conducted through meta-analysis of randomized controlled trials (RCTs) for labor analgesia between the CEI and IEB techniques. The pooled results were presented as weighted mean differences (WMDs) together with 95% confidence intervals (CIs) and odds ratios (ORs) together with 95% CIs, respectively. Eleven RCTs were included in this meta-analysis. Four hundred sixty-five parturients accepted CEI, whereas 473 parturients accepted IEB labor analgesia. Elven identified low- risk bias studies were recruited for meta-analysis. The results presented no statistical difference in cesarean delivery rate between IEB and CEI (OR, 0.96; 95% CI, 0.67–1.37) and duration of second stage of labor (WMD, −3.82 min; 95% CI, −8.28 to 0.64). IEB had statistically significant lessened risk of instrumental delivery (OR, 0.59; 95% CI, 0.39–0.90) and for the use in local anesthetic (WMD, −1.71 mg bupivacaine equivalents per hour; 95% CI, −1.88 and −1.55). Accepted IEB had a higher score of maternal satisfaction (WMD, −6.95 mm; 95% CI, −7.77 to −6.13). Based on evidence, IEB showed a greater benefit for slightly reducing the use in local anesthetic, reduced risk of instrumental delivery, and improved maternal satisfaction for the requirement of labor epidural analgesia for healthy women. In the future, more studies need to be conducted to practice the IEB regimen and explore its influence on labor analgesia.

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Predictors of incomplete maternal satisfaction with neuraxial labor analgesia: A nationwide study

Anaesthesia Critical Care & Pain Medicine ◽

10.1016/j.accpm.2021.100939 ◽

2021 ◽

pp. 100939

Author(s):

Jade Merrer ◽

Marie-Pierre Bonnet ◽

Béatrice Blondel ◽

Muriel Tafflet ◽

Babak Khoshnood ◽

...

Keyword(s):

Labor Analgesia ◽

Maternal Satisfaction ◽

Nationwide Study

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Comparison of effects of low dose ropivacaine with levobupivacaine on quality of analgesia, maternal satisfaction and neonatal outcome during labor through combined spinal epidural approach: A double blind randomized study

Indian Journal of Clinical Anaesthesia ◽

10.18231/j.ijca.2021.045 ◽

2021 ◽

Vol 8 (2) ◽

pp. 230-235

Author(s):

Shruti Sharma ◽

Archana Agarwal ◽

Trilok Chand ◽

Unni Jithendran

Keyword(s):

Randomized Study ◽

Labor Analgesia ◽

Statistical Testing ◽

Secondary Outcome ◽

Epidural Administration ◽

Maternal Satisfaction ◽

Double Blind ◽

Combined Spinal Epidural ◽

Spinal Epidural

Regional techniques in labor analgesia have proven to be very effective, with bupivacaine being the most commonly used drug. This study compares the efficacy of local anaesthetics with lower cardiotoxicity and neurotoxicity such as levobupivacaine and ropivacaine in low doses, administered intrathecally followed by Patient Controlled Epidural Analgesia (PCEA). The primary outcome and secondary outcome of the study was to compare the quality of analgesia (verbal rating score) and maternal satisfaction respectively. The Double blind prospective randomized study included 60 parturients of ASA I and II with 37-41 weeks of singleton pregnancy in active labor, cervical dilatation >4 cm, with no obstetrical or medical complication, requesting painless labor, randomized into two groups (30 each) by a computer generated randomized sequence:Group R- received intrathecal 2.5 mg ropivacaine followed by epidural administration of 10 ml 0.125% ropivacaine Group L- received intrathecal 2.5 mg levobupivacaine followed by epidural administration of 10 ml 0.125% levobupivacaine. The primary and secondary outcome of the study was to compare the quality of analgesia and maternal satisfaction respectively. Statistical testing was conducted with the statistical package for social science system version (SPSS) 17.0. Group R had late onset and shorter duration of action with lesser motor blockade, however the results were statistically insignificant. Group L had slightly less total consumption of local anaesthetic and better maternal satisfaction, but was statistically insignificant. Patients in both groups had statistically similar pain scores at various intervals. Both levobupivacaine and ropivacaine are highly effective for labor analgesia using the combined spinal epidural (CSE) technique.

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